Login
×
New cases 1 Finished cases 12

Неврологія Нейрохірургія

case № 0012
Diagnosis:

Diagnosis - residual effects of cerebrovascular accident (in 2008) - spontaneous intracerebral hemorrhage in the right temporal area with ​​rupture in liquor spaces. Posthemorrhagic liquor cyst of the right frontal area without displacement. Left-side hemiparesis. Symptomatic epilepsy. Retardation of speech II st. Kyphoscoliosis. 

Case description:

Date of birth - 08.09.2008

 

Complaints  -  myoclonic seizures, which occur at night, restlessness at night, gate disturbance, emotional lability.

 

Second child in the family, from immediate delivery, which proceeded without complications. Discharged from the hospital on the 3rd day. At 2 months the child's mother noticed fever and vomiting, then seizures. Was suspected tumor of brain, were phenomena of intracranial hypertension and focal neurological symptoms. The dynamics on CT, MRI - hemorrhage, resorption of hemorrhage.

 

Clinical diagnosis - spontaneous intracerebral hemorrhage in the right frontal and temporal lobes of the brain with ​​rupture in liquor spaces. Posthemorrhagic liquor cyst of the right frontal area without displacement. Left-side hemiparesis. Liquor cyst in the right frontal lobe was drained.

 

Medicamentations -  Depakine, Gidazepamum. Periodically undergoes rehabilitation.

 

Neurological status at the moment – In consciousness, the contact is available. Emotionally disinhibited. Hemiparetyc walk; during walking - internal rotation of the left foot. Posture - kyphoscoliosis. Self – serving skills - eating, getting dressed by her own. Tendon reflexes - D> S from the hands and lower extremities.

 

The EEG - during EEG - monitoring of regional night's sleep revealed epileptiforming activity (frequent, single and serial spikes of slowing activity) from anterior temporal zone dealing with periodic spread in the right central area. Epileptiforming activity is recorded in all stages of sleep. Physiological patterns expressed satisfactorily (preferably in the left hemisphere). Cycling EEG - sleep phases are not violated.

 

On MRI of the brain (06. 07. 2015) - in the right frontal part is determined liquor cavity of irregular shape with clear contours with size 9.2 * 5.2 * 6.5 cm, which connects to the front corner of the right lateral ventricle. Posterior parts of right lateral ventricle are dilated to 1.9 cm. Throughout other departments of  the ventricular system are not changed. Moderately extended cavity of Vergae. Backwards from liquor cavity brain substance of superior temporal region and posterior frontal region are reduced in volume, MR - signal from it is patchy, hyperintensive on T2VI, hypointensive on T1VI in its projections appear multiple areas of encefalomalation. Similar changes in the area of ​​length to 2.3 cm are observed in parts of the medial cingulate gyrus. Corpus callosum is evident only in the posterior part. Optic chiasma, pituitary gland, pons departments, cerebellum without focal changes. Formations of the middle line is not shifted.

 

Conclusion - MR - signs of destructive changes in the brain due to suffering from intracerebral hemorrhage. Condition after drainage of liquor cyst.

 

Baranik Karina

The wishes of parents - quality diagnostics, consultations of neurologist and neurosurgeon

case № 0010
Diagnosis:

The progressive kyphosis of thoracic part of spine. Sherman - Mau disease. Deformation of trunk. Pain syndrome.

Concomitant diseases - pulmonary stenosis I st. (15 mm Hg)

Case description:

 

Date of birth -20.01.2002

 

The disease started to progress two years ago. Now there is an exacerbation of pain syndrome.

 

 

 

 

Voznyuk Veronica 

The wish of parents - providing of surgical treatment.

case № 0004
Diagnosis:

The сonsequences of endured neuroinfection - encephalitis (2008) as low flaccid paraparesis, psycho-organic syndrome, symptomatic epilepsy - generalized сloniс - tonic seizures. Hypermetropia of Ist degree in both eyes.

Case description:

The child is 7.5 years old.
      Complaints on the growth rate of seizures, the absence of speech, behavioral disorders, falling while walking. Seizures during the last 6 months - rarely. Antiepileptic therapy child does not get because of the side-effects in the form of ataxia, hypersomnia, vomiting.
      The child was born from the II pregnancy, which passed on the background of the threat of interruption at 7-8 weeks, ARVI in 20-21 weeks and 40 weeks of gestation. During childbirth - once tight entanglement of umbilical cord around the neck of the fetus. The child's condition worsened on the second day of life - in the form of respiratory failure, seizures. In the Intensive care unit was diagnosed congenital pneumonia, further additionally investigated liquor - without pathologic changes. The patient was discharged with improvement of health. In age of 2 months child was treated one more time because of bilateral pneumonia.
          At age 3 months for 1 month child was treated in the hospital with a diagnosis: Chronic flaccid non - identified encephalitis, presumably specific etiology, with the development of compensated hydrocephaly,paraparesis of lower extremities. During examination (PCR of cerebrospinal fluid) - DNA of cytomegalovirus, herpes simplex type I and II - have been not found.
        Neurological status at the moment: cerebro - brain innervation - symmetrical palpebral fissures, active photoreactions. Babbling speech.Locomotive and reflex activity: active movements are not restricted. The muscle tone has a tendency towards hypotonia. No verbal contact. Tendon reflexes and periosteal reflexes in the upper extremities D = S, active, in the lower extremities D = S, torpid. No sensitivity disorders. Pathological signs are absent. Tension symptoms negative.Vegetative nervous system: prompt white dermographism. The function of the pelvic organs is not broken, no skills of neatness.
Child is in need of constant help of a third part in the performance of self-service functions (eating, drinking, walking with assistance), completely dependent from the mother.

Soltys Vladymyr


Parents wish: - consultation of neurologist, neurosurgeon (if necessary, other specialists)
- examination of the child
- determination if is needed medical treatment
- the main task - to improve the psycho - motor development of the child
Budget case.

case № 0003
Diagnosis:

Congenital defect of development of brain - agenesis of corpus callosum, internal occlusive hydrocephaly in stage of subcompensation, low spastic tetraparesis. Moderate mental retardation, underdevelopment of speech II st. Disorders of psychological development. Symptomatic epilepsy.

Case description:

Child is 11 years old. The child is from the first pregnancy on background of fetoplacental insufficiency with chronic hypoxia of fetus. On 41 week of gestation – delivery with stimulation. Baby"s weight at birth – 4350 g. Apgar score – 3/5 points. In newborn period – tonico- clonic convulsions (left hand, mimic muscles) and breathing disorders. From the 1-st day of life baby was treated in pathology of newborns in Ternopil regional hospital. On additional ventilation of lungs – 13 days. In age of 2 months baby was consulted in Institute of Neurosurgery in Kyiv. On the moment of objective examination baby didn"t need neurosurgery treatment ( conclusion of neurosurgeon – subcompensated hydrocephaly after intracranial haemorrhage on background of severe perinatal encephalopathy of hypoxic – ischemic character). Up to 6 months there was intensive enlargement of liquor ways (D – 55 mm, S – 60 mm, III – 10 mm). Child started to turn from side to side in 10 months, started to crawl, to sit by himself from 1 year 2 months,to walk by himself in 1 year 11 months, first words from 1 year 5 months. Treatment: dehydratation medicaments (diakarb +asparcam, glycerin mixture) vascular therapy (actovegin, cynnarizin, tanacan), cerebroprotectors and nootropes, homotoxycological preparates " Heel", vitaminotherapy, craniosacral therapy. In 7 years age tonico – clonic convulsions recovered (1-2 times a month). Anticonvulsive drugs baby took up to 2 months (Depakin), later – parents refused. In 2014 convulsions were 1 time in 2-3 months with duration from 60 seconds to 3 minutes, finished by themselves without treatment, had tonico – clonic character, sometimes without loss of consciousness. On this moment remission – 10 months. Neurological status : general condition is disturbed . On examination child reacts negatively. On questions child doesn’t answer, but there are signs of interest and facial motor actions. Size of head 55 cm, hydrocephal shape of head. Cranial brain innervation. Nonaccomodation convergent squint from the left side, hypersalivation is non – stable (during emotions and inflectional diseases it increases). Walk is spastic – paretic. Muscle tonus is distonic with hypotonia of trunk and hypertonus in distal parts of lower extremities, more expressed from the left. Ostal and periostal reflexes are higher from hands D>S, expressive, fast disappear from lower extremities S>D. Spontaneous Babinsky reflex which appeares from both sides. Coordinative probes child doesn’t provide. Communication is not good developed. In night time social skills are present, in day time – not always present. Simple commands child understand, can perform, says some words, plays, disinhibited, attention is quickly exhausted, emotions are unstable, meteosensitive.

Popovych Vladyslav

Parents wish: - consultation of neurologist, neurosurgeon, speech therapist (if necessary, other specialists)

- Examination of the child

- Determine if child need medical treatment

- Identify key moments of rehabilitation and restorative treatment of the child

- The main task - to improve the psycho - motor development of the child

Budget case.

case № 0002
Diagnosis:

Malignant tumour of basis of the skull (cranio - fascial hemangiopericytoma) with extra – intracranial dissemination (clinoid space, ethmoid bone, maxillary sinus)

Case description:

Patient is sick since 2008, when appeared complaints of headaches and fits of unmotivated irritation.There was diagnosed tumor of of basis of the skull. 02.07.08 patient had an operation - partial removal of extracerebral tumor of anterior cranial fossa from the right side.During the operation developed massive parenchymal bleeding from tumor vessels. Because of severe bleeding and hemodynamic infringement operation was stopped. After stabilization of condition was performed second operation 22.07.08 - total removal of extracerebral tumor of anterior cranial fossa from the right side. On histological examination was observed anaplastic hemangiopericytal meningioma with extensive areas of necrosis. Subsequently, MRI found that tumor growth is continuing. 06.04.2011 because of this, next operation was done. 12.12.2014 to patient was performed one more operation - subtotal removal of extracerebral tumor of anterior cranial fossa from the right side. Radiological therapy was used in 2011 - without the desired effect.

case № 0001
Diagnosis:

Epileptic encephalopathy with frequent therapeutically resistant polymorphic epi-attacks (partial myoclonic, tonico -clonic seizures, partial tonic seizures - syndrome of Lennox - Gastaut ) in a child with a congenital abnormality of the brain - the corpus callosum hypoplasia. Spastic tetraparesis more expressed from the right side with moderately stable dysfunction, retardation of psycho-lingual development.

Case description:

Child is from 3rd pregnancy, 3rd immediate delivery, which proceeded without complications. The weight of the baby at birth - 3500 g. At 4 - day of life in the child began neonatal seizures. Consulted in OHMATDET (in Kyiv). From medications takes sabril, clonazepam. Neurological status: productive contact is absent, microcephal shape of the skull with flattened asymmetric occiput, horizontal nystagmus, muscle tone diffusely decreased with relative hypertonus in extensors of feet, high knee reflexes with the expansion of reflexogenic zone,klonus of the feet, Babinsky s-m on both sides. Baby doesn"t stand and sit by herself.